Local Care Provision: Hepatology Services

Our Hepatology service is supported by the Hepatology team which provides an inpatient and outpatient service (as well as Community outreach supported by Hepatology Clinical nurse specialists). The service is complimented by a very motivated team contributing towards Research, Audit and Training.

Hepatobiliary Conditions

  • Alcohol related liver disease (ArLD)
  • Assessment of abnormal liver function tests
  • Autoimmune related liver disease including Primary Sclerosing Cholangitis(PSC), small duct PSC,Primary Biliary Cholangitis(PBC), autoimmune hepatitis and IgG4 related disease
  • Bile duct abnormalities, Cholestatic liver disease
  • Gall bladder disease
  • Inherited and metabolic liver disease including: Wilson’s disease, alpha-1-antitrysin deficiency, haemochromatosis
  • Liver cirrhosis and it’s complications, such as ascites, variceal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy, Hepatorenal syndrome, Hepatopulmonary syndrome
  • Focal liver lesions
  • Hepatic malignancies
  • Non-alcohol related liver disease(NAFLD)
  • Vascular liver disease e.g. Budd-Chiari syndrome
  • Viral hepatitis

Procedures for Hepatobiliary disease done locally

  • Complex endoscopic retrograde cholangiopancreatography (ERCP)

  • Percutaneous biliary drainage (PTC/PTD)

  • ERCP: Endoscopic retrograde cholangipancreaticography for patients with obstructive jaundice

  • Laparoscopic cholecystectomy / open cholecystectomy

  • HPB cases are referred to Upper GI MDT which happens locally at WHH on Monday morning and following discussion depending on the need there is onward referral to Tertiary Centre for further management. Other cases of benign HPB are discussed with our local upper GI surgical team

  • Percutaneous Liver biopsy supported by Radiologist who help to do this under USG guidance. We have histopathologist who takes special interest in Liver and GI, also helps to liaise with tertiary center for reports
  • Paracentesis: Inpatient for sick patients in Gastro ward and Outpatients in Ambulatory Care supported by Acute Physicians

  • Fibroscan : This service is nurse led , we have 3 machines across the various sites including CAP software to assess the degree of steatosis

  • Endoscopy : Upper GI endoscopy for varices, variceal banding , glue injection

  • Gastrointestinal haemorrhage: Vascular interventional radiology support available for embolization

Procedures which require referral to Tertiary Centre

  • Transjugular Liver biopsy
  • Transjugular intrahepatic portosystemic shunt (TIPS)
  • TACE (Transarterial Chemo-embolisation )/TARE (Transarterial radio-embolisation)
  • RFA (Radiofrequency ablation )
  • Chemotherapy /Immunotherapyfor Hepatocellular Cancer (HCC)
  • Liver transplantation
  • ERCP : spy glass , EHL or Post transplant biliary strictures , Hilar strictures requiring rendevouz approach
  • Endoscopic Ultrasound


Hepatology  Governance

  • We have monthly Hepatology meetings to discuss operational issues, audits , training, research and service provision

  • The Hepatology clinical nurse specialist have a weekly clinical meeting with Dr Jayshri Shah to highlight any patients reviewed by them in their OPC which require urgent attention

  • We have monthly Clinical /Academic meeting to discuss complex cases /interesting cases filtered through the weekly clinics for onward review

  • We Audit our performance, focusing on key targets and parameters as suggested by British Association of Study of Liver and British Society of Gastroenterology

  • We have a dedicated research team to support Hepatology research trials.